> The filtering, testing requirements, and frankly unpleasantness involved in medicine (in the United States) not only drives the curve to the right,

What makes you think that they are filtering for good physicians? Or even filtering for those who are capable of becoming doctors?

Here in South Africa, post-1994, universities adopted a very aggressive affirmative action policy to correct imbalances of the past. While med-schools had previously been based purely on merit, post-1994 introduced quotas for each of the major race groups.

This meant that a disadvantaged-background student with a C average would often be picked over an advantaged student with an A average.

The result was still doctors who graduated, and then went on to practice. The restriction by med-schools everywhere is not because only high-performing students will survive it, it's a purely artificial restriction.

After all, if C average students pass, why not simply increase the intake?

The problem with this is that there is zero evidence that the filtering and testing requirements correlate with actual doctoring skills. In fact there is evidence against this.

Think of it this way; in Europe it is far easier to become a doctor then in the US due to significantly less stringent requirements. However in Europe and other 1st world countries treatment and other quantitative measures on quality of medical care beat the US by a far margin.

It shows that the "unpleasantness" is pushing something to the right of the bell curve. However it is clearly not pushing "effective medical diagnosis and treatment" to the right of the curve as Europe is beating us on that front with far less stringent requirements.

For example, the current residency process in the US demands regular 80-100 hours weeks[1] for years, and was designed by a man who was basically high on cocaine 24/7 and expected the same out of all doctors.

[1] It's supposed to be legally limited to 80, but ask around and it's obvious that even that limit isn't properly enforced.

Not only in the US, Europe is the same(Portugal and Spain at least). It is absolutely ridiculous to expect life critical care from people who are working those hours. No other critical profession would even dare having those hours(pilots, drivers, etc) yet it is expected that doctors are somehow super humans. I think that is what they want to imply, as well as get boatloads of money on demand due to pay per hour.

The safety impact of long working hours for pilots and drivers is clear but for medical residents it's more complex. Tired doctors do make more mistakes. But in hospital care settings, serious medical errors happen most frequently in transitions of care from one doctor to another. Shorter working shifts mean more transitions.

No, what they imply is 1.that if you're not certified, you're essentially a slave labourer and 2.that long hours are essential to get enough training to become good.

The big problem is that 2 is true.

Americans like to believe that becoming a doctor is so much harder in the US. This is not true. I am a foreign medical grad. It is actually pretty easy to get a passing mark on your exams, and from that pov your system is not what it seems. What's hard in the US is getting into med school. But it's not that much harder than in Europe, apart from the cost of course, which acts as the major barrier in your country.

In fact, education and medical systems are different enough between Europe and the US that saying one is harder is very subjective. For instance, american specialists are really hyperspecialized. They often excel at what they do, and are completely ignorant of other fields. Europeans often have a much broader medical knowledge. They are also far less aggressive. All in all, I much prefer Europe.

I actually don't know first hand. I only heard it was easier and thought it was a well known fact. Thanks to your comment I think it may just be a popular myth rather than a well known fact.

Either way if you're saying the "hardness" is the same, the conclusion still stands. "Hardness" is not the metric that is making European quality of care better than the US because both countries have the same "hardness".